Responses to a question about ‘overall satisfaction with the appointment system’, which had been answered on a 7-point Likert scale, were dichotomised to ‘completely and very satisfied’ versus all other categories. This was the dependent variable in a multilevel logistic regression undertaken using the XTLOGIT command in STATA (version 9.2). The proportion of same-day appointments was grouped into units of 10 and treated as a continuous variable. The effect of the proportion of same-day GP appointments was tested, adjusted for potential confounding factors at the practice level (number of GP appointments offered in total by the practice per 1000 population, training practice or not, receiving deprivation payments or not, previously been fundholders or not, and list size), and at the patient level (age, sex, chronic illness status, and ethnicity). Interaction terms between the proportion of same-day GP appointments and being older, having a chronic condition (defined as reported longstanding illness, disability, or infirmity) and practice in receipt of deprivation payments were tested to determine whether the acceptable balance of same-day and booked in advance appointments differed by type of patient or practice.
How this fits in
Recent policy initiatives related to government targets for primary care access have led to changes in the numbers of appointments that are reserved for patients booking on the day. There has been concern about difficulties with booking appointments in advance. This study found that increasing the proportion of same-day GP appointments was associated with a reduction in patient satisfaction with appointment systems, particularly in older patients. Practices should be wary of increasing the level of same-day appointments to meet access targets.
